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Q&A: Understanding New Cover Oregon Exchange

Oregonians who don’t already have health insurance from their employer can start to enroll in the state’s new insurance exchange Tuesday. Those with pre-existing conditions can’t be turned away. And if you make about $46,000 a year or less, or $94,000 for a family of four, you may qualify for a tax credit. There are still a lot of questions about how it’s going to work. OBP Morning Edition host Geoff Norcross put some of those questions to health care reporter Kristian Foden-Vencil.

The Cover Oregon website.

Rebecca Roberts Galloway / OPB

Geoff Norcross: We’ve heard some cute advertising about Cover Oregon. But what exactly is it?

Kristian Foden-Vencil: Yeah. The best way to think about Cover Oregon is to think about a travel website like Travelocity or Expedia. You want health insurance, but you want to compare prices, benefits, deductibles, co-pays and all the rest. So you go to Cover Oregon, plug in your information and pick the plan that’s right for you.

GN: What kind of information?

KFV: Well, the basics: Social Security Number, expected income for next year, family status.

GN: So who gets coverage and who doesn’t?

KFV: Well, if you get your insurance through your work, that’s likely to stay the same. This insurance is for individuals who aren’t covered, or who may already be buying their own insurance now, and people who work for small businesses.

If you make less than 138 percent of the federal poverty limit, you’ll be directed to join the Oregon Health Plan. If you make more, you’ll get your insurance through one of the dozen or so companies on the exchange — like Kaiser, LifeWise, Providence — those kinds of insurers.

GN: So is everything expected to run smoothly?

KFV: No. For the first couple of weeks or so, Cover Oregon wants people to enroll using either an insurance agent or what they’re calling a “navigator,” that’s someone with a group like the Urban League of Portland or the Asian Health and Service Center. There are about 30 organizations in Oregon that have received a grant to help people enroll.

The state is doing it this way because Cover Oregon expects some glitches. So to start with, Cover Oregon will be closed on the weekends and at night so those wrinkles can be ironed out. Then, after a few weeks, you’ll be able to sign up for insurance yourself.

GN: Will an agent charge a fee?

KFV: No. Their commissions are built into your premium.

GN: Well, what’s to stop people from remaining uninsured and then picking up insurance once they get sick?

KFV: Basically, you can only get insurance during open enrollment. Now, open enrollment lasts for six months this year to try and get everyone signed up. But after that, the window gets smaller. The exception to that is that small businesses. They can enroll anytime.

Image illustrating choosing a health plan from the Healthcare.gov website.

Healthcare.gov

GN: Well, why’s that?

KFV: The idea is that’s it’s not the business that gets sick and suddenly needs health insurance. So the business can enroll anytime, but the employees have to enroll in the window.

GN: But what happens if I decide to risk it and just not get insurance?

KFV: Well, in 2014 you’re subject to a tax penalty. It starts at $95. But over time, it ramps up. By 2016 it’s a minimum of almost $700 or up to 2.5 percent of family income.

GN: We’ve all seen headlines about higher premiums. Is the new insurance going to be more or less expensive?

KFV: In a word: Both. If you’re young and healthy, it’s likely to be more expensive, mainly because a lot of young people haven’t been buying insurance. So if you’re younger than about 50, could be more. If you’re older, it’s likely to be less — because the pool of people grows bigger and healthier.

The healthcare.gov website.

Healthcare.gov

GN: Is there anything people should look out for?

KFV: The state is warning people to look out for scammers who may use this to get hold of your personal information. Also, make sure that you sign-up with coveroregon.com and not another private insurer. coveroregon-dot-com is the only place you’ll be able to get a federal tax credit if you’re eligible.

GN: So when do people actually get insurance?

KFV: Coverage starts January 1st.

What do you have to do when Cover Oregon goes live? Use the form below to find out.